One of the biggest struggles for those of us living with Crohn’s and Colitis is our relationship with food. I would like to preface this post by saying that there is a lot of debate amongst medical professionals as to whether diet plays a role in IBD or not and so a lot of GIs are hesitant to even talk about it aside from advising staying away from lots of fibre while in a flare. There are lots of diets that show promise such as the Mediterranean, SCD, Paleo, low FODMAP, GAPS and Crohn’s Disease Exclusion diets but everyone’s body is different and unfortunately there is no one size fits all. It should also be noted that a lot of these diets are only meant to be used short term to identify personal triggers. With all of that being said, a lot of us can feel completely lost after receiving our diagnosis, trying to identify triggers and experience a lot of anxiety when it comes to reintroducing certain things. This can lead to over restricting and disordered eating which is why I would suggest that everyone with IBD or other GI disorders work with a registered dietician at some point in their journey. Keeping a food journal, at least for the first few months after diagnosis, can also be helpful when trying to identify trigger foods and gaps in your nutrition.
As a kid I LOVED food and I was fortunate to grow up in a place where I was exposed to a variety of different cuisines. The only food I didn’t really enjoy was bread and buns because of how they made me feel (an early sign of my gluten intolerance). In the years leading up to my diagnosis I suddenly had a lot of trouble eating because of the nausea and abdominal pain I was experiencing. As I mentioned in my diagnosis story, this led to anorexia (not to be confused with the eating disorder anorexia nervosa) and malnutrition. After I was diagnosed and began treatment, the nausea subsided and my appetite began to return but my relationship with food was forever changed. I was afraid of a lot of foods, particularly fruits and vegetables, because I didn’t trust them to not cause pain or inflammation. I started out my Crohn’s journey sticking to a low fibre/low residue diet which meant a lot of rice, potatoes, meat, pasta, and white bread. My only fruits and vegetables were well cooked carrots and canned green beans as well as canned peaches, applesauce, and ripe bananas. Eventually I started to get tired of this diet and found that all the carbs and lack of fibre were making my bloating, constipation, and gas pain worse. I also began to experience severe psoriasis. All of this led me to do research on the impact of diet and IBD. Amazingly what I discovered was that the usual diet of refined carbs and low fibre prescribed by doctors was actually lacking in nutrients and very bad for inflammation and that a lot of people with IBD actually struggle with gluten intolerance as well. After identifying gluten, whole grains, refined carbs and sugar, whole nuts and seeds, most raw fruits and veggies, coffee, legumes, animal fat, highly processed oils, fried foods, and high lactose dairy as my main triggers, I began my journey with a modified version of the paleo and SCD diets, focusing on lean meats, cooked veggies, good fats like olive, avocado and coconut oil, and healthy, more nutrient dense carbs like sweet potato and squash. Eventually I added in the low lactose dairy encouraged on the SCD diet such as hard cheeses as well as gluten free grains like oats and rice to make it an even more well rounded diet. While I still had trouble with raw veggies, the increase of soluble fibre in my diet through cooked veggies and fruit in the form of smoothies made an enormous difference in my energy levels and overall health. Soluble fibre is found in the flesh of fruits, legumes and vegetables as well as oatmeal and flaxseeds. This type of fibre is easier on the digestive system as it draws water from the colon, dissolves in that water, and helps gel stool together making it easier to pass. Insoluble fibre is more prevalent in raw produce and is mainly found in the skins/peels, membranes/casings, stalks/stems, strings and seeds of fruits, nuts, meats, and vegetables, especially ones in the cruciferous family and dark, leafy greens. This type of fibre does not break down or dissolve in the digestive system. To an inflamed and ulcerated digestive system, this can cause blockages, increased gas, bloating, and watery stools. Learning this information was extremely helpful in my journey to enjoying a balanced diet while living with IBD and something that I wish my GI would have discussed with me. For example, I could still eat broccoli, I just needed to trim the stalks, steam it well and keep my portions smaller. Pureeing foods high in insoluble fibre is another way to still enjoy them with IBD as it breaks down the skins and seeds, preventing them from clogging up your digestive tract. This allowed me to still enjoying berries in the form of smoothies.
Fast forward to one year later. Although the paleo diet had made an improvement in my inflammation numbers, the years of going undiagnosed plus the failure of my new medication left me with areas of scar tissue and permanent narrowing/stiffening in my small bowel. This led to partial blockages and painful bloating and gas buildup. I was again forced to resume a low fibre, grain free diet and relied heavily on pureed sweet potato, carrot and butternut squash soups, banana smoothies, plain eggs and protein shakes for my nutrition. It also brought a renewed sense of fear regarding food. I hated being so restricted in not only what I ate but how it was prepared which led me to push for surgery. Since my surgery I have been blessed to have reached remission. Although I am in remission, I am still working at getting over my fear of certain foods, especially ones higher in insoluble fibre, but have found myself slowly starting to trust my body again. Wherever you are at in your IBD journey and relationship with food, my advice would be to be patient and give yourself and your body grace. Be open and honest with your family and friends about how you are feeling and let them know how best to support you. Finally, don’t be afraid to tell your GI when your struggling with your current treatment plan. You know your body best and deserve to feel your best and be heard.